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Algorithm for treating chronic back pain
Last reviewed: 23.04.2024
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The algorithm for treating chronic back pain is as follows:
- Determination of the cause of pain and its pathophysiology;
- Assessment of the intensity of pain syndrome;
- Assessment of the physical and mental state of the patient. Accounting for comorbid disorders;
- Monitoring the effectiveness of therapy;
- Prophylaxis and correction of side effects.
In 1998, WHO proposed a so-called anesthesia staircase, demonstrating the principles of escalating analgesic treatment. Proposed originally for the treatment of cancer pain, this scheme has become universal.
- Do not opioids: aspirin, paracetamol, NSAIDs
- Weak opioids: tramadol, codeine, dihydrocodeine
- Strong opioids: morphine, diamorphine, fentanyl, buprenorphine, oxycodone, hydromorphine
Adjuvants: antidepressants, anticonvulsants, steroids, muscle relaxants (for example, tizanidine, baclofen), bisphosphonates (for example, zoledronic acid, alendronic acid, ibandronic acid), calcitonin, exercise, physiological support, thermotherapy, traditional medicine, hydrotherapy, acupuncture.
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